Breaking bad news in the oncologic population: Residents' perspective.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e24113-e24113
Author(s):  
Vihitha Thota ◽  
Mahati Paravathaneni ◽  
Sudheer Konduru ◽  
Bohdan Baralo ◽  
Sana Mulla ◽  
...  
Keyword(s):  
Patient Care ◽  
Health Care Providers ◽  
Confidence Level ◽  
Statistical Significance ◽  
Further Education ◽  
Bad News ◽  
Care Providers ◽  
Prior Training ◽  
Oncologic Patients ◽  
Delivering Bad News

e24113 Background: Delivering bad news to patients is a delicate but required skill for doctors as part of patient care. There has been evidence that good communication from health care providers can improve patients' compliance to treatment as well as be beneficial emotionally. While many studies have been done in regards to patients' perceptions of receiving bad news, there are limited studies looking at a physicians' perspective, and even more so concerning residents' perceptions. In community hospitals, many patients are diagnosed with cancer, and resident physicians are often responsible for informing the patients and their families regarding the diagnosis. The manner in which the news is delivered is important, however it is unclear how much training is provided to residents before they are required to break bad news to patients. The lack of training can often result in improper delivery and poor patient care. Methods: We surveyed Internal Medicine and General Surgery residents at Mercy Catholic Medical Center, a conglomeration of two community teaching hospitals in Philadelphia, about prior training, confidence level, attitudes, and need for further education on delivering bad news to oncologic patients using a survey created after extensive research. The factors associated with confidence level were analyzed using paired T-test and ANOVA methods. Results: A total of 65 residents (72%) participated. No statistical significance was seen between American versus foreign medical graduates, MD vs. DO residents, or among those in different specialties when assessing their confidence in delivering bad news. Though only 62% of participants reported having had prior training in delivering bad news, residents with previous training (p1) or who have had to deliver bad news previously (p2) reported higher confidence when it came to delivering a new diagnosis of cancer (p1 0.03, p2 0.001), delivering news regarding the progression of cancer (p1 0.03, p2 0.02), delivering news regarding the recurrence of cancer (p1 0.04, p2 0.002), and delivering news regarding end-stage cancer with little to no treatment options left (p1 0.04, p2 0.003). 100% of participants thought communicating bad news is an important skill for a physician, and 92% of participants thought further education would help prepare them for similar scenarios in the future. Simulated patient scenarios (64%), grand rounds lectures/presentations (59%), and feedback from faculty after actual patient scenarios (57%) were the most requested whereas pamphlets/brochures (17%) and online training courses (20%) were less popular. Conclusions: Our study highlights the importance of prior training or exposure among residents in being able to deliver bad news to patients effectively. We propose that implementing further training in the form of simulated scenarios and lectures can improve residents' confidence at delivering bad news and result in a better physician-patient relationship.

scholarly journals How to deliver bad news to me? Suggestions for preparing Muslim patients before breaking bad news

2020 ◽  
pp. 147775092095954
Author(s):  
Akram Sadat Sadat Hoseini
Keyword(s):  
Health Care Providers ◽  
Human Growth ◽  
Bad News ◽  
Spiritual Needs ◽  
Breaking Bad News ◽  
Family Needs ◽  
Care Providers ◽  
Breaking Bad ◽  
Different Cultures ◽  
Delivering Bad News

There are several models for delivering bad news, the most important and widely used being the SPIKES protocol. Cultural differences in breaking bad news in different societies with different cultures call for special attention. Muslim societies are examples of communities with special cultural and religious requirements. Then, when collecting information about a person's perception of the illness or the incident, consider his or her view of spirituality and the effect of calamities on human transcendence so as to assess the type and amount of information the patient or the family needs. When preparing a suitable setting for delivering bad news, pay attention to the spiritual needs of Muslims such as the possibility of prostration, recitation of Qur'an, and talking to God in private or even aloud. Be aware of, pay attention to, and respect particular religious views of the patient, and if necessary, correctly exploit such views to deliver bad news. Although some Muslim patients may have no demands for transcendence and human growth at the first stage, but over time and after accepting the condition, they will have demands. Therefore, health care providers must provide the necessary facilities for Muslim patients in terms of the required information, setting, and people present in the setting and provide information appropriate to the culture of these patients so as to give an excellent and comprehensive care.

Extended Breastfeeding in Poland: Knowledge of Health Care Providers and Attitudes on Breastfeeding Beyond Infancy

2018 ◽  
Vol 35 (2) ◽  
pp. 371-380 ◽  
Author(s):  
Barbara Baranowska ◽  
Marta Malinowska ◽  
Ewelina Stanaszek ◽  
Dorota Sys ◽  
Grażyna Bączek ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Health Professionals ◽  
Further Education ◽  
Self Report ◽  
Care Providers ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Level Of Knowledge ◽  
The Relationship

Background: Extended breastfeeding is rare in Poland, and lack of acceptance and understanding is often evident in public opinion. The ability to provide reliable information about breastfeeding beyond infancy depends on health professionals’ levels of knowledge and attitudes. They are considered by most parents in Poland to be authorities in the field of child nutrition. Research aims: To determine (1) the level of knowledge and the attitudes of Polish health professionals towards extended breastfeeding; (2) the relationship between personal breastfeeding experience and attitudes towards extended breastfeeding; and (3) the relationship between knowledge about breastfeeding beyond twelve months and attitudes towards breastfeeding beyond infancy. Methods: A one-group prospective, cross-sectional, self-report style survey was used. The convenience sample ( N = 495) comprised gynaecologists, neonatologists and midwives. Data were collected via an online questionnaire and the results were analyzed with the use of descriptive statistics, a chi-square independence test, Fisher’s exact test, post-hoc testing, and two-part tables using SPSS. Results: Most of the respondents (76.7%; n = 384) had a low level of knowledge about the benefits of breastfeeding beyond twelve months and even emphasized that this nutritional choice could have negative impacts. There was a positive correlation ( F = 105.847; p = < .01) between levels of knowledge and respondents’ attitudes towards breastfeeding beyond infancy. Attitudes were also influenced by the length of time respondents had breastfed. Conclusion: Healthcare providers have an insufficient level of knowledge about extended breastfeeding and need further education in this area.

scholarly journals Utilization of Non-Pharmacological Methods and the Perceived Barriers for Adult Postoperative Pain Management by the Nurses at Selected National Hospitals in Asmara, Eritrea

2020 ◽  
Author(s):  
Betiel Yihdego Kidanemariam ◽  
Traudl Elsholz ◽  
Laban L. Simel ◽  
Eyasu H. Tesfamariam ◽  
Yonatan Mehari Andemeskel
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Health Care Providers ◽  
Work Experience ◽  
Statistical Significance ◽  
Demographic Data ◽  
Postoperative Pain Management ◽  
Perceived Barriers ◽  
Care Providers ◽  
Cross Sectional

Abstract Background: Pharmacological methods are widely used for postoperative pain management however, poorly controlled pain continues to pose a significant challenge. Non pharmacological methods could contribute to the unresolved postoperative pain management in assisting nurses’ routine care and reducing the need for medication. This study aimed to assess nurses’ utilization of non-pharmacological methods in postoperative pain and the perceived barriers for their implementation at the National Hospitals.Methods: This was a descriptive cross sectional study conducted among 154 nurses working at the National Referral Hospitals and Sembel Private Hospital. A standardized five-point Likert-scale questionnaire which assesses nurses' utilization of selected non-pharmacological methods and the perceived barriers for the implementation was used to collect data. Descriptive statistics for the demographic data, independent samples t-test, one way ANOVA and factorial ANOVA were used to analyze the data. Statistical significance level was set at P < 0.05.Results: The study found out that emotional support (45.5%), helping with daily activities (67.5%) and creating a comfortable environment (61%) were mostly used while, cognitive-behavioral (5.9%) and physical methods (5.8%) were hardly used. The results also showed that, characteristics such as, age (p=0.013), level of education (p=0.012), work experience (p=0.001) and place of work (p=0.001), were significantly related to the use of non-pharmacological methods at bivariate level. However, hospitals were the only determinants of the non-pharmacological methods at multivariable level with a statistical significance of (p<0.001). On the perceived barriers; heavy work load (87.7%), shortage of time (84.4%), limited resources (82.5%), deficit in the guidelines for pain management (77.3%), patient’s uncooperative behavior (57.1%), language difference (64.4%), nurse’s lack of knowledge (50%) and experience (40.3%) were identified.Conclusion: The use of non-pharmacological methods in the studied hospitals varied greatly on the knowledge and experience of the nurses. Therefore, it is recommended that exposure and training for all health care providers at all level is a paramount importance in order to appreciate the benefits of non-pharmacological methods applicable to postoperative pain management. This could be achieved through on job training, seminars, scientific conferences and other brainstorming forums.

scholarly journals Examining the role of MEDLINE as a patient care information resource: an analysis of data from the Value of Libraries study

2017 ◽  
Vol 105 (4) ◽  
Author(s):  
Kathel Dunn ◽  
Joanne Gard Marshall ◽  
Amber L. Wells ◽  
Joyce E. B. Backus
Keyword(s):  
Health Care ◽  
Adverse Events ◽  
Patient Care ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Information Resources ◽  
Information Resource ◽  
Care Providers ◽  
Other Information

Objective: This study analyzed data from a study on the value of libraries to understand the specific role that the MEDLINE database plays in relation to other information resources that are available to health care providers and its role in positively impacting patient care.Methods: A previous study on the use of health information resources for patient care obtained 16,122 responses from health care providers in 56 hospitals about how providers make decisions affecting patient care and the role of information resources in that process. Respondents indicated resources used in answering a specific clinical question from a list of 19 possible resources, including MEDLINE. Study data were examined using descriptive statistics and regression analysis to determine the number of information resources used and how they were used in combination with one another.Results: Health care professionals used 3.5 resources, on average, to aid in patient care. The 2 most frequently used resources were journals (print and online) and the MEDLINE database. Using a higher number of information resources was significantly associated with a higher probability of making changes to patient care and avoiding adverse events. MEDLINE was the most likely to be among consulted resources compared to any other information resource other than journals.Conclusions: MEDLINE is a critical clinical care tool that health care professionals use to avoid adverse events, make changes to patient care, and answer clinical questions.

Critical Aspects of a Sustainable Clinical Research Program in the Community-Based Oncology Practice

2019 ◽  
pp. 176-184 ◽  
Author(s):  
Jennifer L. Ersek ◽  
Stephanie L. Graff ◽  
Francis P. Arena ◽  
Neelima Denduluri ◽  
Edward S. Kim
Keyword(s):  
Clinical Research ◽  
Patient Care ◽  
Health Care Providers ◽  
Research Program ◽  
Improve Patient Care ◽  
Care Providers ◽  
Community Based ◽  
Technological Infrastructure ◽  
Community Based Research ◽  
Research Programs

Increasing enrollment into clinical trials is a top priority across the field of oncology. Because the vast majority of those afflicted with cancer receive their care in the community, creating strong clinical research programs in the community-based setting is important. This article comprehensively outlines the most important elements of creating and sustaining a successful community-based research program. Establishing a clear mission and defining the scope of the research program in collaboration with key physicians and administrative leadership are critical to success. Standard operating procedures should detail operational processes. Ensuring sound financial planning and protected physician time are crucial for a healthy program. Providing mentorship opportunities to investigators and other team members will provide necessary guidance for junior investigators and long-term program stability. Prioritizing provider and patient volunteer engagement through education and awareness will potentially improve enrollment and research ownership. Incorporating administrative and clinical research staff and health care providers, including physicians, advanced practice providers, and pharmacists, will result in a multidisciplinary and unified approach and may also promote research as a routine part of patient care. Regular safety and scientific meetings will reduce regulatory complications and, most importantly, improve patient care. Other keys to a successful program include establishing a diverse trial portfolio, collaboration between different institutions, and ensuring appropriate technological infrastructure. Serial programmatic review provides opportunities to refine suboptimal practices and recognize successful strategies. Community-based research programs are critical to improve access to optimal cancer care. Implementation of successful programs is possible with a collaborative and multidisciplinary approach.

Which sorts of pharmacies provide more patient counselling?

2002 ◽  
Vol 7 (1_suppl) ◽  
pp. 23-28 ◽  
Author(s):  
Pauline Norris
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Census Data ◽  
Social Deprivation ◽  
Statistical Significance ◽  
Negative Relationship ◽  
Care Providers ◽  
Care Needs ◽  
Patient Counselling ◽  
Large Town

Objective This paper investigates the characteristics of pharmacies that are associated with the degree of counselling provided to customers purchasing medicines. Methods Twelve ‘mystery shoppers’ (research assistants posing as normal customers) purchased restricted medicines at 180 pharmacies around New Zealand. One drug (diclofenac) and one class of drugs (vaginal antifungals) were purchased. The amount of counselling provided was recorded, and linked to profile data on the pharmacies, obtained through a questionnaire, from Census data, and from direct observations of pharmacies. Results Location within a city, a large town, or strip shopping did not affect the level of counselling pharmacies provided. Pharmacies adjacent to medical centres gave significantly less counselling to diclofenac purchasers than other pharmacies. No consistent relationship was found between pharmacy size and the level of counselling provided. There were large differences between areas of the country. A strong negative relationship was found between the amount of counselling given about thrush, and the proportion of Pacific Island people in the population around the pharmacy. Although only some results reached statistical significance, there seems to have been a similar trend for pharmacies to provide less counselling in areas with more Maori people and with higher levels of social deprivation. Conclusions Regional variation in the provision of pharmacy services, and in particular the tendency for pharmacies to provide less counselling in areas that are likely to have higher health care needs, must be addressed if pharmacies are to fulfil their potential as health care providers.

Prescribing an App? Oncology Providers’ Views on Mobile Health Apps for Cancer Care

2017 ◽  
pp. 1-7 ◽  
Author(s):  
Callie M. Berkowitz ◽  
Leah L. Zullig ◽  
Bridget F. Koontz ◽  
Sophia K. Smith
Keyword(s):  
Patient Care ◽  
Health Care Providers ◽  
Mobile Health ◽  
Cancer Care ◽  
Structured Interview ◽  
Mobile App ◽  
Care Providers ◽  
Supportive Services ◽  
Wide Range ◽  
Oncology Providers

Introduction Although there are over 500 mobile health (mHealth) applications (apps) available for download in the field of oncology, little research has addressed their acceptability among health care providers. In addition, the providers’ perspectives regarding patient app use has been largely unexamined. We conducted a qualitative study to explore opportunities and barriers for mHealth app use for oncology care. Methods We developed a structured interview guide focusing on acceptability, appropriateness, feasibility, and sustainability of the use of apps in cancer care. We interviewed 15 oncology providers about their attitudes and preferences. De-identified audio recordings were transcribed and coded for emerging themes. Results Providers interviewed included physicians (n = 8) and advanced practice (n = 3) and supportive services (n = 4) providers who care for a wide range of cancer types; ages ranged from 32 to 68 years. Interviews lasted approximately 30 minutes. Oncology providers reported limited exposure to mHealth apps in patient care, but were generally open to recommending or prescribing apps in the future. Key themes included opportunities for mobile app use (including general health promotion, tracking symptoms, and engaging patients) and barriers to implementation (including access to technology, responsibility, workflow, and the source of the app itself). Conclusion Our results show openness among oncology providers to using mHealth technology as part of patient care, but concerns regarding implementation. Designing acceptable apps may be challenging and require involvement of key stakeholders, partnering with trustworthy institutions, and outcome-based research.

scholarly journals Oral Health Attitudes among Preclinical and Clinical Dental Students in Germany

2020 ◽  
Vol 17 (12) ◽  
pp. 4253 ◽  
Author(s):  
Mohamed Mekhemar ◽  
Jonas Conrad ◽  
Sameh Attia ◽  
Christof Dörfer
Keyword(s):  
Health Care ◽  
Oral Health ◽  
Health Care Providers ◽  
Oral Hygiene ◽  
Dental Education ◽  
Statistical Significance ◽  
Dental Students ◽  
Care Providers ◽  
Health Attitudes ◽  
German Universities

Oral health care providers are expected to show good examples of oral health behaviours and attitudes to their community. Previous studies displayed the constructive effect of dental education on oral hygiene manners of undergraduate students. The aim of this survey was to assess and compare aspects of oral health attitudes and behaviours between preclinical and clinical dental students in German universities. The German-language version of the HU-DBI was distributed to preclinical and clinical students from different German universities. Dichotomized (agree/disagree) responses to 20 HU-DBI items were provided in this study, with a maximum possible score of 19. A quantitative estimate of oral health attitudes and behaviours was provided by the total of appropriate answers given to every statement by each group. Data were analysed statistically. The overall mean score of answers favouring good oral hygiene was marginally higher in preclinical (14.62) than clinical students (14.31) but showed no statistical significance. Similarly, the analysis of each item individually displayed no statistically significant differences between preclinical and clinical participants, except in a single item of the survey. This study showed no effective differences in oral hygiene attitudes and behaviour between preclinical and clinical students in German universities. This reveals a weak effect of dental education on improving students’ oral health attitudes in Germany and might demand the introduction of more courses emphasizing the importance of correct oral health behaviour of health care providers.

Using On-scene EMS Responders’ Assessment and Electronic Patient Care Records to Evaluate the Suitability of EMD-triaged, Low-acuity Calls for Secondary Nurse Triage in 911 Centers

2016 ◽  
Vol 31 (1) ◽  
pp. 46-57 ◽  
Author(s):  
Greg Scott ◽  
Jeff Clawson ◽  
Mark C. Fivaz ◽  
Jennie McQueen ◽  
Marie I. Gardett ◽  
...  
Keyword(s):  
Patient Care ◽  
Health Care Providers ◽  
Vital Sign ◽  
Clinical Status ◽  
Vital Signs ◽  
Care Providers ◽  
Emergency Medical Dispatch ◽  
Emergency Medical ◽  
Alpha Level ◽  
Nurse Triage

AbstractIntroductionUsing the Medical Priority Dispatch System (MPDS) – a systematic 911 triage process – to identify a large subset of low-acuity patients for secondary nurse triage in the 911 center is a largely unstudied practice in North America. This study examines the ALPHA-level subset of low-acuity patients in the MPDS to determine the suitability of these patients for secondary triage by evaluating vital signs and necessity of lights-and-siren transport, as determined by attending Emergency Medical Services (EMS) ambulance crews.ObjectivesThe primary objective of this study was to determine the clinical status of MPDS ALPHA-level (low-acuity) patients, as determined by on-scene EMS crews’ patient care records, in two US agencies. A secondary objective was to determine which ALPHA-level codes are suitable candidates for secondary triage by a trained Emergency Communication Nurse (ECN).MethodsIn this retrospective study, one full year (2013) of both dispatch data and EMS patient records data, associated with all calls coded at the ALPHA-level (low-acuity) in the dispatch protocol, were collected. The primary outcome measure was the number and percentage of ALPHA-level codes categorized as low-acuity, moderate-acuity, high-acuity, and critical using four common vital signs to assign these categories: systolic blood pressure (SBP), pulse rate (PR), oxygen saturation (SpO2), and Glasgow Coma Score (GCS). Vital sign data were obtained from ambulance crew electronic patient care records (ePCRs). The secondary endpoint was the number and percentage of ALPHA-level codes that received a “hot” (lights-and-siren) transport.ResultsOut of 19,300 cases, 16,763 (86.9%) were included in the final analysis, after excluding cases from health care providers and those with missing data. Of those, 89% of all cases did not have even one vital sign indicator of unstable patient status (high or critical vital sign). Of all cases, only 1.1% were transported lights-and-siren.ConclusionWith the exception of the low-acuity, ALPHA-level seizure cases, the ALPHA-level patients are suitable to transfer for secondary triage in a best-practices, accredited, emergency medical dispatch center that utilizes the MPDS at very high compliance rates. The secondary nurse triage process should identify the few at-risk patients that exist in the low-acuity calls.ScottG, ClawsonJ, FivazMC, McQueenJ, GardettMI, SchultzB, YoungquistS, OlolaCHO. Using on-scene EMS responders’ assessment and electronic patient care records to evaluate the suitability of EMD-triaged, low-acuity calls for secondary nurse triage in 911 centers. Prehosp Disaster Med. 2016;31(1):46–57.

A Novel ICU Hand-Over Tool: The Glass Door of the Patient Room

2016 ◽  
Vol 32 (8) ◽  
pp. 514-519 ◽  
Author(s):  
Brian T. Wessman ◽  
Carrie Sona ◽  
Marilyn Schallom
Keyword(s):  
Critical Care ◽  
Patient Care ◽  
Health Care Providers ◽  
Night Shift ◽  
Surgical Trauma ◽  
Care Providers ◽  
Improvement Project ◽  
Glass Door ◽  
Patient Handover ◽  
Communication Errors

Background: Poor communication among health-care providers is cited as the most common cause of sentinel events involving patients. Patient care in the critical care setting is incredibly complex. A consistent care plan is necessary between day/night shift teams and among bedside intensive care unit (ICU) nurses, consultants, and physicians. Our goal was to create a novel, easily accessible communication device to improve ICU patient care. Methods: This communication improvement project was done at an academic tertiary surgical/trauma/mixed 36-bed ICU with an average of 214 admissions per month. We created a glass door template embossed on the glass that included 3 columns for daily goals to be written: “day team,” “night team,” and “surgery/consultant team.” Assigned areas for tracking “lines,” “antibiotics,” “ventilator weaning,” and “Deep vein thrombosis (DVT) screening” were included. These doors are filled out/updated throughout the day by all of the ICU providers. All services can review current plans/active issues while evaluating the patient at the bedside. Patient-identifying data are not included. We retrospectively reviewed all ICU safety reported events over a 4-year period (2 years prior/2 years after glass door implementation) for specific handover communication-related errors and compared the 2 cohorts. Results: Information on the glass doors is entered daily on rounds by all services. Prior to implementation, 7.96% of reported errors were related to patient handover communication errors. The post glass-door era had 4.26% of reported errors related to patient handover communication errors with a relative risk reduction of 46.5%. Due to its usefulness, this method of communication was quickly adopted by the other critical care services (cardiothoracic, medical, neurology/neurosurgery, cardiology) at our institution and is now used for over 150 ICU beds. Conclusions: Our glass door patient handover tool is an easily adaptable intervention that has improved communication leading to an overall decrease in the number of handover communication errors.

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